Digital Commons Network^™

Human Health Risk Assessment Related With Heavy Metals Contamination In Rice: A Case Study In Palembang, South Sumatra, Indonesia, Dian Islamiati

Chulalongkorn University Theses and Dissertations (Chula ETD)

Heavy metal pollution is still one of the environmental problems globally, including Indonesia. One of these contaminations comes from agricultural products such as rice. Heavy metal contamination in rice is known to cause various health problems. This study aimed (1) To find Heavy metals concentration in Indonesian local rice (2) To find Non-cancer risk related to heavy metals contaminations in rice (3) To find cancer risk related to heavy metals contaminations in rice (4) To find association between associated factors with risk related to heavy metals contaminations in rice. The rice was collected from the 3 biggest local markets in …

An Exploratory Study Of Online Socialising And Hiv-Related High-Risk Sexual Behavior Among University Students In Chengdu, People’ S Republic Of China, Qin Bo

Chulalongkorn University Theses and Dissertations (Chula ETD)

Young students in China have emerged as a high-risk demographic for HIV infection. Recent research findings confirm that engaging in unprotected sex with multiple partners remains the primary contributor to HIV transmission. However, in light of the ever-evolving landscape of network socialization and the deepening comprehension of HIV among young students, their attitudes and behaviors towards the virus have exhibited distinct characteristics. This study focuses on university and college students in Chengdu as the target population, aiming to comprehensively comprehend the present state and distinctive patterns of their sexual conduct, particularly high-risk sexual behavior. Moreover, it investigates the influence of …

Predictors Of Fertility Quality Of Life In Infertile Patients Visiting Infertility Center In Kathmandu, Nepal : A Cross-Sectional Study., Shital Shakya

Chulalongkorn University Theses and Dissertations (Chula ETD)

In Nepal, infertility is a rising reproductive health issue with an estimated prevalence of 15%. There are few studies on quality of life in infertile women, but none on quality of life in infertile men and women although infertility is a shared condition and has effects on couples. The study objective is to describe the various predictors of infertile patients seeking infertility treatment and find association between these predictors and the quality of life. A cross-sectional study using a self-administered disease specific FertiQoL questionnaire was conducted among 409 infertile men and women seeking infertility treatment in an infertility center in …

Effectiveness Of Urban Childcare Center Indoor Air Quality Management Program (Ucc-Iaq) On Building Related Symptoms Among Care Takes :A Quasi Experimental Study, Sudkhed Detpetukyon

Chulalongkorn University Theses and Dissertations (Chula ETD)

This study investigates the effectiveness of the UCC-IAQ program in Thai childcare centers, focusing on BRS and indoor air pollution. It involves 81 childcare workers in Nonthaburi and Saraburi provinces, Over eight hours, air quality measurements were taken at ten settings. Data on BRS and building-related factors were collected via surveys. Statistically significant differences in pollution levels were not observed between the UCC-IAQ program's intervention and comparison groups. However, the intervention group experienced a significant decrease in BRS compared to the comparison group. Caretakers in rooms with rapid temperature variations had a 10.72 times higher likelihood of experiencing BRS (Adjusted …

Addressing Gender-Based Violence Using Evidence-Based Practices During Covid-19: The Case Of Puerto Rico, Ayorkor Gaba, Roseanne Flores, María Rebecca Ward, Bailey Pridgen

Publications and Research

As gender-based violence (GBV) surged during the COVID-19 pandemic, the 65th session of the Commission on the Status of Women (CSW65) called for member states, civil, and other stakeholders to consider the specific needs of women and girls in COVID-19 response and recovery efforts. Psychology provides scientific knowledge to help answer this call. Despite existing global guidance and psychological research to mitigate GBV, COVID-19 presents new challenges for consideration. This article summarizes existing GBV guidance/research and COVID-19 considerations, uses an illustrative case study to describe Puerto Rico’s application of GBV guidance/research during COVID-19, and provides preliminary policy and practice recommendations.

Detailing The Genetic And Environmental Influences Shared Between Conventional And Electronic Cigarette Use Across Measures Of Initiation And Past 12-Month Use, James Clifford

Theses and Dissertations

Introduction. Tobacco use is a public health crisis with nearly 500,000 Americans suffering premature mortality attributable to tobacco use in 2014. New development efforts have created new nicotine delivery systems whose health consequences are not yet fully understood such as electronic cigarettes (ECIG). It is possible there are shared genetic and environmental factors that influence an individual’s liability to initiate cigarette (CIG) or ECIG use, as both systems are designed to deliver nicotine.

Methods. Four study designs were used to resolve the genetic and environmental influences that underlie CIG and ECIG initiation. A twin study, scoping review, genome-wide association study …

Mathematical Models Of Infection Prevention Programs In Hospital Settings, Kelly A. Reagan

Theses and Dissertations

Hospitals play a vital role in providing for the healthcare needs of a community. Patients can develop hospital-acquired infections (HAIs) during their hospitalization due to exposure to foreign bacteria, viruses, and fungi. Infection prevention programs target and reduce HAIs, but implementing the infection prevention programs often comes with a cost. The goal of my research is to use mathematical models to quantify the impact of infection prevention programs on cases of HAIs and total healthcare costs. First, I use a Markov chain model to quantify how one infection prevention program reduces general HAIs in the hospital. Then, I calculate the …

Behavioral Screening And Chiral Bioanalysis Of Emerging Stimulant-Type Drugs In Rats, Tyson R. Baird

Theses and Dissertations

The epidemic of drug use in the United States and elsewhere in the world has resulted in tragic loss of life and substantial economic costs. Novel psychoactive substances (NPS) are one of the contributors to this problem, and the lack of information about many of these drugs compounds their risk. This dissertation proposes a strategy to use intracranial self-stimulation (ICSS) as a behavioral screening tool to assess emerging drugs of abuse for their abuse potential in order to generate a proactive threat assessment. A series of stimulant-type drugs including methcathinone, α-pyrrolidinohexanophenone (α-PHP), cocaine, and the phenyltropane analogs of cocaine WIN35428 …

Clinicians Experience Using The Family As A Unit Of Treatment For Black Hiv-Positive Men Who Have Sex With Men, Steffen Gillom

Antioch University Dissertations & Theses

The present study examines the experiences of five licensed clinicians as they attempted to integrate the family as a unit of treatment into the treatment of Black HIV-positive men who have sex with men (BHPMSM). A single 90-minute focus group study using an interpretive phenomenological approach (IPA) was conducted with five clinicians from diverse backgrounds. The results of the study show that clinicians attempting to integrate the family into the treatment of BHPMSM shared common experiences in the areas of building community through encouraging client self-determination, navigating religion, navigating HIV stigma, feelings of incompetence, and feelings of gratification after successful …

Performance Of Peltier Cooled Technology During Preconcentration Of Volatile Organic Compounds Analyzed By Gas Chromatography-Mass Spectrometry (Gc-Ms) Using Niosh Manual Of Analytical Methods (Nmam) 3900, Elizabeth Ann Fernandez

Graduate Theses, Dissertations, and Problem Reports (ETD)

Using evacuated canisters for whole-air sampling allows for sampling without specific knowledge of the environment and potential analytes. Evacuated canisters are able to tolerate concentrations ranging from parts per trillion (PPT) to parts per million (PPM). The U.S. Environmental Protection Agency (EPA) has used evacuated canisters for years to sample volatile organic compounds (VOCs) from ambient air using their method TO-15 (LeBouf, et al., 2019). The GC-MS system used for the development of NMAM 3900 used liquid nitrogen to cool sorbent traps in the preconcentrator. Liquid nitrogen allows for cooling of specified points below ambient temperature. An alternative to liquid …

The Combination Of Tlr7/8 And Tlr4 Adjuvants In An Influenza Vaccine Produce Unique Antigen-Specific Adaptive Immunity And Protect Against Lethal Heterologous Influenza Challenge, Shelby Lynn Cole

Graduate Student Theses, Dissertations, & Professional Papers

Influenza virus infection is a global health concern resulting in death and illness each year, which disproportionally effects high-risk individuals. While there are several approved vaccines for seasonal influenza, there are some limitations to consider: current vaccines provide minimal cross protection against seasonally drifted influenza subtypes, influenza vaccine strains change each year, requiring timely manufacture of a new vaccine. Thus, vaccines capable of inducing a more robust and broadly protective immune response to multiple influenza subtypes remains a critical unmet need. Adjuvants and novel delivery systems are an interesting and promising avenue of exploration for enhancing and broadening seasonal influenza …

Alzheimer's Disease Research Progress In Australia: The Alzheimer's Association International Conference Satellite Symposium In Sydney, Claire E. Sexton, Kaarin J. Anstey, Filippo Baldacci, C. J. Barnum, Anna M. Barron, Kaj Blennow, Henry Brodaty, Samantha Burnham, Fanny M. Elahi, Jürgen Götz, Yun-Hee Jeon, Maya Koronyo-Hamaoui, Susan M. Landau, Nicola T. Lautenschlager, Simon M. Laws, Darren M. Lipnicki, Hanzhang Lu, Colin L. Masters, Wendy Moyle, Akinori Nakamura, Giulio Maria Pasinetti, Naren Rao, Christopher Rowe, Perminder S. Sachdev, Peter R. Schofield, Einar M. Sigurdsson

Research outputs 2014 to 2021

The Alzheimer's Association International Conference held its sixth Satellite Symposium in Sydney, Australia in 2019, highlighting the leadership of Australian researchers in advancing the understanding of and treatment developments for Alzheimer's disease (AD) and other dementias. This leadership includes the Australian Imaging, Biomarker, and Lifestyle Flagship Study of Ageing (AIBL), which has fueled the identification and development of many biomarkers and novel therapeutics. Two multimodal lifestyle intervention studies have been launched in Australia; and Australian researchers have played leadership roles in other global studies in diverse populations. Australian researchers have also played an instrumental role in efforts to understand mechanisms …

A Participatory Group Process To Collect And Disseminate Covid-19 Needs Assessment Data, Areebah Ahmed

UROP Posters

The Richmond, VA COVID-19 Needs Assessment Survey (RVA CoNA) was created in March 2020 to identify behaviors and needs related to COVID-19 in Richmond area adults ages 18 and over. Results are being used to inform support, strategic efforts, and educational outreach of local community organizations. The purpose of this study is to (1) summarize the process used to develop the RVA CoNA, (2) summarize preliminary survey results from a second phase of data collection as well as initial feedback from community partners, and (3) summarize initial conclusions and results dissemination strategies.Community partners and researchers at Virginia Commonwealth University jointly …

Family Structure And Maternal Depressive Symptoms: A Cross-National Comparison Of Australia, The United Kingdom, And The United States, Kirsten Rasmussen, Elizabeth K. Sigler, Sadie A. Slighting, Jonathan A. Jarvis, Mikaela J. Dufur, Shana Pribesh

Educational Leadership & Workforce Development Faculty Publications

The purpose of this study is to understand the relationship between family structure and maternal depressive symptoms (MDS) in Australia, the United Kingdom, and the United States. Family structures that involve transitions across life's course, such as divorce, can alter access to resources and introduce new stressors into family systems. Using the stress process model, we examine the links between family structure, stress, resources, and MDS. Using nationally representative data from Australia, the United Kingdom, and the United States and cross-sectional models for each country, we find that family structure may influence MDS differently in the UK than it does …

Jue Insight: Migration, Transportation Infrastructure, And The Spatial Transmission Of Covid-19 In China, Bingjing Li, Lin Ma

Research Collection School Of Economics

This paper evaluates the impacts of migration flows and transportation infrastructure on the spatial transmission of COVID-19 in China. Prefectures with larger bilateral migration flows and shorter travel distances with Hubei, the epicenter of the outbreak, experienced a wider spread of COVID-19. In addition, richer prefectures with higher incomes were better able to contain the virus at the early stages of community transmission. Using a spatial general equilibrium model, we show that around 28% of the infections outside Hubei province can be explained by the rapid development in transportation infrastructure and the liberalization of migration restrictions in the recent decade.

Widening Health Disparities: Increasing Cholangiocarcinoma Incidence In An Underserved Population, Disha Kumar, Varun Bansal, Syed A Raza, Aaron P Thrift, Hoda M Malaty, Robert J Sealock

Faculty, Staff and Students Publications

BACKGROUND AND AIMS: Cholangiocarcinoma is a relatively rare malignancy with high mortality. In the U.S., incidence rates of cholangiocarcinoma have increased, particularly affecting younger age groups and Hispanic and Asian individuals. We investigated the incidence of cholangiocarcinoma in a largely under-represented, minority population.

METHODS: We performed a retrospective cohort study from 2005 to 2017 among adults in a county-funded healthcare system in Harris County, Texas. Incidence rate ratios were computed to compare age-standardized rates using U.S. standard population between 2 time periods: 2005-2011 and 2012-2017.

RESULTS: We identified 139 cholangiocarcinoma cases (64% intrahepatic, 36% extrahepatic). The median age at diagnosis …

“I Have Nothing More To Give”: Disparities In Burnout And The Protective Role Of Immigrant Status During The Covid-19 Pandemic, Gene Chibuchim Otuonye, Nancy Shenoi, Tianshi David Wu, Kalpalatha Guntupalli, Nidal Moukaddam

Faculty, Staff and Students Publications

Burnout is an epidemic, with deleterious effects on individuals, patient care, and healthcare systems. The Coronavirus Disease 2019 (COVID-19) pandemic may be exacerbating this problem. We aimed to explore socio-cultural and gender norms that modulate burnout development in physicians during the pandemic and analyze any disparities associated with gender, marital and immigration status and work-life balance. We conducted an online cross-sectional survey of physicians (August-November, 2021): The Maslach Burnout Inventory-Human Services Survey (MBI-HSS) was used to measure burnout, combined with a validated survey assessing work-life balance. Demographic data was obtained for each participant. MBI-HSS subscales were measured, along with work …

Creation Of A Global Vaccine Risk Index, Tasmiah Nuzhath, Peter J Hotez, Ashish Damania, P Shuling Liu, Brian Colwell

Center for Medical Ethics and Health Policy Staff Publications

The World Health Organization has identified vaccine hesitancy as one of its top ten global health threats for 2019. Efforts are underway to define the factors responsible for reductions in vaccine confidence. However, as global measles cases accelerated beginning in 2018, it became evident that additional factors were promoting measles re-emergence, including war, political and socio-economic collapse, shifting poverty, and vulnerability to weather events and climate change. Accordingly, we propose a Global Vaccine Risk Index (VRI) to consider these variables as a more comprehensive means to identify vulnerable nations where we might expect measles and other vaccine-preventable diseases to emerge …

Endometriosis-Associated Angiogenesis And Anti-Angiogenic Therapy For Endometriosis, Monica S Chung, Sang Jun Han

Faculty, Staff and Students Publications

Endometriosis is a known estrogen-dependent inflammatory disease affecting reproductive-aged women. Common symptoms include pelvic pain, dysmenorrhea, dyspareunia, heavy menstrual bleeding, and infertility. The exact etiology of endometriosis is largely unknown, and, thus, the diagnosis and treatment of endometriosis are challenging. A complex interplay of many molecular mechanisms is thought to aid in the progression of endometriosis, most notably angiogenesis. This mini-review examines our current knowledge of the molecular etiology of endometriosis-associated angiogenesis and discusses anti-angiogenic therapy, in the blockade of endometriosis-associated angiogenesis, as potential non-hormonal therapy for the treatment of endometriosis.

Dual Orexin Receptor Antagonists For Treatment Of Insomnia: A Systematic Review And Meta-Analysis On Randomized, Double-Blind, Placebo-Controlled Trials Of Suvorexant And Lemborexant, Habibolah Khazaie, Masoud Sadeghi, Sepideh Khazaie, Max Hirshkowitz, Amir Sharafkhaneh

Faculty, Staff and Students Publications

Study objectives: Recent treatment guidelines for chronic insomnia recommend pharmacological and non-pharmacological therapies. One of the contemporary drug options for insomnia includes dual orexin receptor antagonist (DORA), such as suvorexant and lemborexant. We conducted a systematic review and meta-analysis for the treatment of insomnia with suvorexant and lemborexant based on randomized, double-blind, placebo-controlled Trials.

Methods: We conducted a comprehensive search on three databases (PubMed/Medline, Web of Science, and Cochrane Library) till August 14, 2021, without any restrictions to retrieve the relevant articles. The effect sizes were computed presenting the pooled mean difference or risk ratio along with 95% confidence interval …

Sarscov-2 Serostatus Amongst Vaccinated Employees At A Pediatric Hospital System, Sridevi Devaraj, Izmarie Poventud-Fuentes, Matthew Girotto, Jermaine Monroe, Julie Boom, George Delclos, James Versalovic

Faculty, Staff and Students Publications

To gain insights on the heterogeneity of immune responses to vaccination against SARS-CoV-2 and to identify factors that could make individuals vulnerable to infection due to lack of response to vaccination, our hospital started offering free voluntary post-antibody testing against the spike protein IgG for all fully vaccinated employees.

Post-vaccination response against SARS-CoV-2 was assessed using the FDA-EUA approved VITROS anti-SARS-CoV-2 IgG immunometric assay specific to the spike protein.

Out of a total of 3266 antibody tests performed in fully vaccinated Texas Children’s, 99.4% had a positive antibody response to the spike protein. From the 21 employees (0.6%) that had …

Exercise-Induced Myokines Downregulates The Ace2 Level In Bronchial Epithelial Cells: Implications For Sars-Cov-2 Prevention, Vaishali Bhardwaj, Mart Dela Cruz, Deepika Subramanyam, Rohit Kumar, Sandeep Markan, Beth Parker, Hemant K Roy

Faculty, Staff and Students Publications

BACKGROUND: The Covid-19 pandemic has emerged as the leading public health challenge of our time (20th century). While vaccinations have finally blunted the death rate, concern has remained about more virulent forms highlighting the need for alternative approaches. Epidemiological studies indicate that physical activity has been shown to decrease the risk of infection of some respiratory viruses. Part of the salutary effects of exercise is believed to be through the elaboration of cytokines by contracting skeletal muscles (termed myokines). The objective of this study was to investigate whether exercise-induced myokines would mitigate the SARS-CoV-2 infectivity of the bronchial epithelium through …

Identification Of Lung Cancer Drivers By Comparison Of The Observed And The Expected Numbers Of Missense And Nonsense Mutations In Individual Human Genes, Olga Y Gorlova, Marek Kimmel, Spiridon Tsavachidis, Christopher I Amos, Ivan P Gorlov

Faculty, Staff and Students Publications

Largely, cancer development is driven by acquisition and positive selection of somatic mutations that increase proliferation and survival of tumor cells. As a result, genes related to cancer development tend to have an excess of somatic mutations in them. An excess of missense and/or nonsense mutations in a gene is an indicator of its cancer relevance. To identify genes with an excess of potentially functional missense or nonsense mutations one needs to compare the observed and expected numbers of mutations in the gene. We estimated the expected numbers of missense and nonsense mutations in individual human genes using (i) the …

Safety And Efficacy Of Electrical Stimulation For Lower-Extremity Muscle Weakness In Intensive Care Unit 2019 Novel Coronavirus Patients: A Phase I Double-Blinded Randomized Controlled Trial, Alejandro Zulbaran-Rojas, Ramkinker Mishra, Naima Rodriguez, Rasha O Bara, Myeounggon Lee, Amir Behzad Bagheri, James P Herlihy, Muhammad Siddique, Bijan Najafi

Center on Aging Staff Publications

Background: Intensive care unit (ICU) prolonged immobilization may lead to lower-extremity muscle deconditioning among critically ill patients, particularly more accentuated in those with 2019 Novel Coronavirus (COVID-19) infection. Electrical stimulation (E-Stim) is known to improve musculoskeletal outcomes. This phase I double-blinded randomized controlled trial examined the safety and efficacy of lower-extremity E-Stim to prevent muscle deconditioning.

Methods: Critically ill COVID-19 patients admitted to the ICU were randomly assigned to control (CG) or intervention (IG) groups. Both groups received daily E-Stim (1 h) for up to 14 days on both gastrocnemius muscles (GNMs). The device was functional in the IG and …

The Process And Case Study Approach To Implementing A Nutrition-Specific Dissemination And Implementation Science Training In Appalachia, Ayron E. Walker

Graduate Theses, Dissertations, and Problem Reports (ETD)

Introduction: Nutrition professionals face implementation challenges due to their lack of knowledge to incorporate D&I science into intervention design. To improve intervention outcomes, nutrition professionals must be trained in D&I science, which are currently absent in the field.

Aims: To identify and assess nutrition educators and practitioners perceived motivations, self-efficacy, and attitudes in using D&I science to inform the educational design and strategies of a nutrition-specific D&I curriculum for nutrition educators. Then to test feasibility of the nutrition-specific curriculum in increasing knowledge, self-efficacy, and attitudes by a case study approach, pre/post intervention design.

Methods: First, scoping review methodology involved the …

Examining The Pulmonary Response To Repeated Vishniacozyma Victoriae Exposure And Its Association With Allergic Airway Disease, Rachael Erin Rush

Graduate Theses, Dissertations, and Problem Reports (ETD)

Allergic airway diseases such as asthma continue to increase in incidence in industrialized nations like the United States. These diseases are complex inflammatory processes involving numerous cells and mediators and are strongly influenced by fungal exposures. Recent developments in fungal detection methods have highlighted the contribution of Basidiomycota yeast species in indoor environments such as Vishniacozyma (syn. Cryptococcus) victoriae. However, despite the high levels of this yeast detected in indoor environments, very little is known about it or its role in respiratory morbidity. V. victoriae is phylogenetically similar to pathogenic Cryptococcus neoformans but lacks a capsule and is …

An Agent-Centered Approach To Covid-19 Vaccinations, Nila Venkat

CMC Senior Theses

The rise of COVID-19 has dramatically affected the global economy, healthcare systems, and individuals’ daily lives. One of the most controversial attempts to ameliorate the effects of the virus in the United States has been the distribution of COVID-19 vaccinations. In this thesis, I propose a novel agent-centered approach to motivating COVID-19 vaccinations. I begin by exploring the origins and evolution of the virus, along with the growing demographic of “vaccine-hesitant” Americans, to contextualize the debate surrounding vaccinations. I then propose two potential action-based response strategies for vaccine motivation: a vaccine mandate and nudges. Concerning a mandate response strategy, I …

Risk Factors Associated With Mother-To-Child Transmission Of Hiv In Dar Es Salaam, Tanzania, Felix Elias, Nyimvua Shaban, Edwin Rutalebwa

Tanzania Journal of Science

Despite Tanzania's efforts and substantial progress in PMTCT, about 11% new infections were recorded among Tanzanian children in 2019 (UNAIDS 2020a). The objective of this study was to determine the rate of HIV transmission and to identify its risk factors among HIV exposed infants born to HIV-positive mothers in Dar es Salaam, Tanzania. A cross-sectional study was conducted using retrospective data collected from HIV-positive mothers and their exposed babies who were followed and registered in health facilities in four administrative districts (Ilala, Temeke, Kinondoni, and Ubungo) in Dar es Salaam between January 2016 and December 2019.  To identify risk factors …

Absence Of Germline Brca1 C.68_69delag And C.5266dupc Mutations Among Hormone Receptor-Negative Breast Cancer Patients: A First Impression At A Tertiary Cancer-Care Facility In Tanzania, Linus P Rweyemamu, Gokce Akan, Christopher H Mbotwa, Nazima Dharsee, Lucy A Namkinga, Sylvester L Lyantagaye, Ted F Mselle, Fatmahan Atalar

Tanzania Journal of Science

The germline BRCA1 c.68_69delAG (185delAG) and c.5266dupC (5382insC) mutations are associated with hormone receptor-negative breast cancer (BC).  Limited studies have examined their contribution to alarming BC incidence in Sub Saharan Africa (SSA). Our study aimed to examine the contribution of  germline BRCA1 c.68_69delAG and c.5266dupC mutations to BC incidence among hormone receptor-negative BC patients admitted to Ocean Road Cancer Institute in Tanzania. Face-to-face interviews were conducted to capture socio-demographic characteristics, anthropometric measurements, family history of cancer and reproductive information from each patient. Their  histopathological data were extracted from the hospital medical records. The germline BRCA1 founder mutations were analyzed on …

Mitigating The Spread Of Measles Under Constrained Health Care Resources In Tanzania Using Social Contact Network Models, Herieth Rwezaura, Seán Mcgarraghy

Tanzania Journal of Science

Tanzania revaccinates individuals during measles outbreaks, despite having scant healthcare resources. We construct epidemiological models of measles spread by employing a hybrid of existing social contact networks models to develop SEIR simulation model. Using demographic and measles surveillance data from three rural villages in Tanzania, we simulate the spread of measles and examine which vaccination strategies can effectively control outbreaks. Results strongly indicate the spread of measles largely depends on contact rates among infected individuals within a population. Findings indicate a need for targeted vaccination for children of 6 months to 15 years of age, but equally for unvaccinated older …